One-stage total repair of aortic arch anomaly using regional perfusion

Objective: Primary repair of aortic arch obstructions and associated cardiac anomalies is a surgical challenge in neonates and infants. Deep hypothermic circulatory arrest prolongs myocardial ischemia and might induce cerebral and myocardial dysfunction. Methods: From March 2000 to December 2005, 69 neonates or infants with aortic arch anomaly underwent one-stage biventricular repair with continuous cerebral perfusion in the presence of a nonworking beating heart using the dual perfusion technique on the innominate artery and aortic root. Preoperative diagnoses of arch anomaly comprised aortic coarctation (n = 54) or an interrupted aortic arch (n = 15). Combined anomalies were ventricular septal defect (n = 52), anomalous origin of the right pulmonary artery from ascending aorta (n = 3), hypoplastic left heart syndrome (n = 2), truncus arteriosus (n = 2), atrioventricular septal defect (n = 2), double outlet right ventricle (n = 1), total anomalous pulmonary venous return (n = 1), partial anomalous pulmonary venous return (n = 1), and aortic stenosis (n = 1). Results: The mean regional perfusion time was 27.8 ± 9.8 min. There was no operative mortality. Postoperative low cardiac output was present in four patients (5.8%). A neurologic complication was noted in one patient (1.5%) who developed transient chorea, but recovered completely. During 32.8 ± 17.5 months of follow-up, one late death (1.5%) occurred. There was neither reoperation associated with arch anomaly nor recoarctation except in one patient. One patient developed left main bronchial compression necessitating aortopexy. Conclusions: One-stage total arch repair using our regional perfusion technique is an excellent method that may minimize neurologic and myocardial complications without mortality. Our surgical strategy for arch anomaly has a low rate of residual and recurrent coarctation when performed in neonates and infants.